This is TB's moment and it must be seized

Jeremy Farrar

DirectorWellcome

Two scientific breakthroughs and a global meeting on tuberculosis mean there is an opportunity to move TB from the doldrums, says Wellcome's Director Jeremy Farrar. But great science needs to be matched by greater global commitment, ambition and political will.

25-year old Hanif has drug-resistant TB (XDR-TB). After having failed treatment for the fourth time, he was referred to the Médecins Sans Frontières clinic for treatment.

Momentous. There is no better word to describe news of scientific breakthroughs announced against the world’s biggest infectious killer – tuberculosis.

Every day it takes almost 5,000 lives. It is staggering that 136 years since German microbiologist Robert Koch discovered the bacteria responsible for TB, none of the world’s 195 countries have eradicated this devastating disease.

But now, thanks to the prodigious efforts of two international research teams, two critical milestones have been reached:

When Koch, at the time a German government health adviser, published his TB findings he opened the way to the diagnosis and cure of a disease dating back to ancient civilisations.

But TB has proved tough and adaptable. Advances to treat and prevent it have not kept pace. There have been only two new drugs in the last 50 years and though, in theory, TB is treatable, patients face a best-guess regime of months of hundreds of pills. For those with resistant TB, treatment lasts up to two years.

And of 10 million new cases every year, 4 million are undiagnosed and untreated.

Tailored TB care for all

By teaming cutting-edge technology with new knowledge of TB drug-resistance, there is potential to develop rapid tests to give patients real-time diagnosis. Finally, we are moving towards tailored TB care for all.

A new vaccine offers the chance to protect lives.

There are caveats, as there always are. We don’t, for example, know yet whether these results from studies of 3,500 people, reported by GSK and Aeras in the New England Journal of Medicine, will pan out when tested in tens of thousands, or whether the new vaccine can protect young children, or older people, or those with HIV.

But these are not the barriers to ending TB that pose the most threat to progress.

To advance global health, to make a step-change, you need an intervention but you also need systems that can deliver it where it’s needed, and a community willing to embrace and use it.

Money is a factor undoubtedly – TB receives less than a fifth of global research funding. But this is not simply about a funding call.

We need bold, new ways to reduce R&D costs and to ensure that when great discoveries reach the market they are affordable and available wherever a patient is in the world. Innovative science needs to be matched by innovative financing.

These may be challenging but they can be achieved, as we are starting to see with the new treatment bedaquiline, now treating patients worldwide with costs, access and stewardship being managed.

And we must rid TB of stigma. It is not a disease of poverty or past generations. Low and middle-income countries are, by far, worst affected. But this is a disease of today, that affects us all, including the USA and countries in the EU. To date, 123 countries have reported cases of the most extreme, drug-resistant strains.

Through my career I’ve seen efforts against cancer, malaria and HIV all at various times in a similarly bleak place – patients and families neglected, the research community pessimistic, innovation hard to achieve and then, often, reluctantly embraced.

We must reset TB as a problem brilliant minds of a new generation want to solve

Success breeds success and there is an opportunity to be grasped to move TB research, public health and clinical care in the same way as cancer, HIV and malaria have moved forward over the last two decades.

TB is one of the greatest health challenges of our time

World leaders have committed to ending the TB epidemic by 2030. But without greater ambition, commitment and political will that global goal will not be achieved for another 150 years, never mind in little more than a decade. It can be.

The global high-level meeting on TB in New York is only the fifth ever devoted to a single health issue. This is TB’s moment. It must be seized.

This opinion piece first appeared in The Telegraph on 26 September 2018.

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